HPV treatment may involve prescription medications applied to the skin (ointments or topical solutions) or procedures such as cauterization, cryotherapy, or laser therapy to remove warts or precancerous lesions.
The best option depends on how many warts are present, where they are located, what they look like, and the type of HPV-related lesion. Treatment should follow guidance from an OBGYN, urologist, colorectal specialist, or ENT (ear, nose, and throat specialist).
Regardless of the treatment used, good genital hygiene and condom use during all sexual activity are important. It is also important for a partner to be evaluated by a clinician to determine whether they have been infected and, if needed, start appropriate treatment.
Main types
The main HPV treatment options include:
1. Ointments
Ointments for HPV, such as imiquimod, podofilox, or sinecatechins, may be prescribed to treat genital warts.
For common warts or plantar warts, a clinician may recommend products containing salicylic acid or lactic acid, for example.
2. Topical solutions
Topical solutions for warts are often applied in a medical office because they can contain higher concentrations of ingredients used to destroy wart tissue.
In these cases, a clinician may apply podofilox or trichloroacetic acid solutions for genital warts.
In addition, for warts in the urethra, a clinician may instill a solution containing 5-fluorouracil into the urethra during urethroscopy to remove the warts.
3. Injections into the wart
In some cases, a clinician may inject medication directly into an HPV-related wart.
These injections may be done with interferon beta, which helps limit HPV multiplication in infected cells by interrupting further cell replication.
4. Cryotherapy
Cryotherapy is a procedure performed by a clinician by applying liquid nitrogen to an HPV-related wart.
This treatment freezes the wart, which can cause it to fall off within a few days.
Cryotherapy for HPV may be used for genital warts, plantar warts, common warts, or throat warts, for example.
5. Cauterization
Cauterization is an HPV treatment that may be recommended when HPV-related lesions are present on the cervix, even when genital warts are not seen.
Cauterization may also be recommended for small genital warts on the penis, anus, or vulva.
The goal is to treat lesions and prevent progression, reducing the risk of cervical, penile, or anal cancer.
6. Laser surgery
Laser surgery is another option for genital warts, plantar/common warts, or laryngeal papillomatosis caused by HPV.
A clinician uses a focused beam of light on the wart to destroy the wart tissue.
7. Cone biopsy (conization)
Conization is a procedure used when precancerous lesions are present on the cervix.
An OBGYN removes a cone-shaped piece of cervical tissue, which is then sent to a lab for analysis.
In some cases, conization is the whole treatment. In others, additional treatment may be needed, depending on the lab results.
8. Excisional surgery
Excisional surgery to remove genital warts caused by HPV may be recommended when lesions do not go away with medications or when they are very large. It can be done in a medical office or a hospital.
Surgery may also be recommended when high-grade HPV-related lesions are identified on the cervix.
Excisional surgery can also be used for genital warts on the penis or anus, throat warts, or laryngeal papillomatosis.
9. Loop electrosurgical excision procedure
Loop electrosurgical excision procedure (LEEP) is used to treat HPV-related precancerous lesions on the cervix.
An OBGYN uses an instrument with a thin wire loop that carries electrical current to remove the affected tissue and send it for biopsy.
Results of the biopsy can then be used to guide treatment.
10. Regular medical follow-up
Regular follow-up is recommended to confirm whether HPV treatment worked and to detect new warts or lesions early, so other treatments can be used if needed.
During follow-up, tests may be performed, such as a Pap smear, urethroscopy, anoscopy, laryngoscopy, colposcopy, and biopsy when necessary.
Signs of improvement
When treatment is followed as directed, signs of improvement may include fewer warts and smaller warts, which can also lower the risk of spreading HPV.
However, warts may come back because the virus can remain dormant in the body and is not eliminated simply by removing the warts.
When treatment is not followed as recommended, more lesions may appear and the risk of complications, including cancer, may be higher.